The effect of e-cigs as a gateway for cigarettes was very large for low risk kids, an adjusted odds ratio of 8.6, compared to the odds ratio of 3.5 for the intermediate-to-high-risk kids.

They also highlight the importance of other tobacco products as starter products for kids, although the differential effect on low-risk kids seen with e-cigarettes is not present for the other products.

February 4, 2019

Peter Hajek and colleagues published “A Randomized Trial of E-cigarettes versus Nicotine-Replacement Therapy” in the New England Journal of Medicine. This is a well-done trial comparing e-cigarettes with nicotine replacement therapy among people enrolled in smoking cessation programs in England. In addition to being randomized to e-cigs or NRT, people in the study had ar least 4 weeks of counselling. At one year the cigarette abstinence rate was 18.0% among patients randomized to e-cigs compared to 9.9% randomized to NRT, nearly a doubling of quitting.

The study is thoughtfully designed and cautiously interpreted. The authors also did a nice set of sensitivity analyses to show that the results are robust to the usual kinds of problems one has in doing a randomized controlled trial.

They conclude that “E-cigarettes were more effective for smoking cessation that nicotine-replacement therapy, when both products were accompanied by behavioural support.” I agree with that conclusion.

February 3, 2019

Bonnie Halpern-Felsher and her colleagues at UCSF and Georgia State University submitted this public comment to FDA. It is based on Bonnie's testimony to the FDA meeting on treating youth nicotine addiction. (You can view the slides from the meeting here.) The bottom line from the health testimony at the meeting is that there are not yet proven nicotine addiction treatments for youth and that the FDA needs to concentrate on preventing the addiction in the first place. As this comment discusses, there are a lot of things FDA could and should do right nowby simply enforcing existing law. FDA should also stop making statements about the safety and efficacy of e-cigarettes for harm reduction and cessation that would be illegal if a company made them without first demonstrating their accuracy. These statements also promote youth use of e-cigarettes and the subsequent nicotine addiction.

This comment has Regulations.gov tracking number 1k3-980i-sotq; a PDF is available here.

February 3, 2019

Lauren Lempert, Bonnie Halpern-Felsher and I submitted this public comment to FDA. It is based on Lauren's testimony to the FDA meeting on treating youth nicotine addiction. (You can view the slides from the meeting here.) The bottom line from the health testimony at the meeting is that there are not yet proven nicotine addiction treatments for youth and that the FDA needs to concentrate on preventing the addiction in the first place. As this comment discusses, there are a lot of things FDA could and should do right nowby simply enforcing existing law. FDA should also stop making statements about the safety and efficacy of e-cigarettes for harm reduction and cessation that would be illegal if a company made them without first demonstrating their accuracy. These statements also promote youth use of e-cigarettes and the subsequent nicotine addiction.

This comment has Regulations.gov tracking number 11kk33--998800ii--qzzmii; a PDF is available here.